W. Jefferson Pendergrast Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

015409 Issued in GA

Practice address

2505 Flair Knoll CT NE
Atlanta, GA 30345-1311

Phone

(404) 636-2332

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302739200000",
    "number": "1376603894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 FLAIR KNOLL CT NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303451311",
            "telephone_number": "404-636-2332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 FLAIR KNOLL CT NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303451311",
            "telephone_number": "404-636-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAST",
        "first_name": "W. JEFFERSON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2011-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "015409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Pencek, RDN
• Bojana Borislavova Pencheva, GENETIC COUNSELOR
• Carlotta R Pender, MA, LPC
• Kirstin Pender, PA-C
• Caroline Goodall Pendergrast, PT
• Albert Martin Pendleton, M.D.
• Eugene Banks Pendleton III, M.D.
• Knikki Childs Pendleton, PHARMD
• Tiffany Pendleton
• Andrew McLeod Pendley, MD

• Specialist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.